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Existing issues make battling COVID-19 at nursing homes even more difficult

By Natalie Anderson

SALISBURY — The COVID-19 pandemic has exacerbated longstanding issues in the nursing home industry, including operating on limited resources and attracting enough employees, says Adam Sholer, president and CEO of North Carolina Health Care Facilities Association.

Further, the impact can be even deadlier to nursing homes, which house vulnerable, at-risk populations of people who likely have underlying conditions that make them less likely to recover from COVID-19 complications, Sholer said. That the work often requires close contact between caregivers and patients makes it harder to prevent the spread of COVID-19.

The Citadel Salisbury, a nursing home located on Julian Road, is one of three congregate living facilities in Rowan County with an active COVID-19 outbreak. It has been a hot bed for positive COVID-19 cases and deaths in both Rowan County and across the state.

As of Thursday, a total of 373 individuals have tested positive for COVID-19 in Rowan County. The Citadel represents 144 positive cases and 17 of the total 22 COVID-19 deaths in the county. Four other deaths were residents of the N.C. State Veterans Home, and one who was not associated with a congregate living facility. Liberty Commons is another congregate living facility with an active outbreak.

State health officials this week provided more data on congregate living facilities by releasing the name, number of positive cases and deaths at those facilities, with updates by 4 p.m. every Tuesday and Friday. Those facilities comprise nursing homes, residential care and correctional facilities. And as of Tuesday, data shows the Citadel as having more positive COVID-19 cases — 144 — than any other nursing home in the state. The N.C. State Veterans Home in Salisbury has 16 lab-confirmed cases.

Statewide, 10,509 individuals have tested positive for COVID-19 of the 128,517 tests conducted. Additionally, 378 individuals have died and 546 are currently hospitalized across the state. Nursing homes make up the plurality of active cases and deaths in congregate living facilities statewide, with 1,649 lab-confirmed cases and 169 deaths. Additionally, there are 49 outbreaks at nursing home facilities across North Carolina.

Citadel administrator Sherri Stoltzfus described to in a Salisbury Post story published Thursday how COVID-19 reached its current scale at the facility. But despite the facility’s preparation for the outbreak, she’s still unsure of the spread since many individuals who tested positive were asymptomatic.

Sholer said the state association, which includes 390 members including the Citadel, took “an early lead” during the week of March 9 to advocate for state and federal government assistance to put in place visitation restrictions. That same week, Gov. Roy Cooper officially restricted visitors to congregate living facilities, such as nursing homes.

But Sholer added that it’s important for nursing home staff to be mindful of the asymptomatic spread due to the nature of how “personal” the care is for the vulnerable, at-risk population. That includes baths and assistance with using the bathroom.

He said the appropriate response at this time is to test all nursing home facility residents since so many can be asymptomatic. But he added “that kind of testing isn’t being done in or around our communities.” That’s why there are so many cases at facilities like the Citadel, he said, implying that there would be many more cases in the general public if similar testing of the entire population was possible.

“Everyone’s learning more about this virus and the disease it causes,” Sholer said, adding that he’s “lost count” of how many times guidance has changed as new information is learned about COVID-19 each day.

Though Stoltzfus said the facility is adequately staffed overall, there are shifts that require more staff than what’s available.

Sholer said nursing homes in the state have struggled with obtaining enough staff for years now and paying appropriate wages for the jobs. He said the association has been working with state leaders for two years now to help grow the labor force, starting at the high school level.

Additionally, Sholer said North Carolina is one of several other states looking upon guidance from the CDC and the Centers for Medicare and Medicaid Services to admit positive COVID-19 patients, who are no longer acutely ill but still need some rehabilitation, to congregate living facilities in an effort to free up hospital space. But as of now, both Stoltzfus and Dawn Wilson, who serves as the regional director for Citadel owner Accordius Health, said the Citadel is not currently participating in that program.

“I think it’s really time that we rally around our frontline caregivers and our nursing home employees because this work really is hard,” Sholer said, adding that battling a pandemic makes it harder.

Contact reporter Natalie Anderson at 704-797-4246.



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